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EMERGENCY MEDICINE

Association of Pharmacist Presence on Compliance with Advanced Cardiac Life Support Guidelines During In-Hospital Cardiac Arrest

Clinical Specialist, Emergency Medicine, Department of Pharmacy, Blount Memorial Hospital, Maryville, TN; Assistant Professor, Department of Clinical Pharmacy, College of Pharmacy, University of Tennessee, Knoxville, TN

J Alex Eppert, MD

Emergency Medicine Physician, Team Health MidSouth, Southeastern Emergency Physicians, Department of Emergency Medicine, Methodist Medical Center, Oak Ridge, TN

Reprints: Dr. Draper, College of Pharmacy, University of Tennessee, 1924 Alcoa Highway, Box 117, Knoxville, TN 37920, fax 865/974-2022, hdraper{at}utmem.edu

BACKGROUND: The pharmacist has many potential roles as part of the resuscitation team during cardiopulmonary arrest. Limited published research has evaluated the practice of advanced cardiac life support (ACLS) during in-hospital arrest. Recent reviews indicate that an audit of in-hospital resuscitation practices should be performed to guide future resuscitation training programs for hospital personnel.

OBJECTIVE: To assess compliance with ACLS guidelines during in-hospital cardiopulmonary arrest in a community teaching hospital and evaluate the association of compliance with the presence of a pharmacist on the resuscitation team.

METHODS: A retrospective analysis of the records of 74 consecutive in-hospital arrests occurring between January 1, 2003, and June 30, 2004, was conducted to evaluate compliance with American Heart Association ACLS guidelines.

RESULTS: A total of 74 arrests were evaluated. Noncompliance was noted in 58.1% of all documented arrests; of the 650 treatment interventions identified, 10.6% were noncompliant with ACLS guidelines. The reasons cited for noncompliance included an incorrect medication dosage (20.3%), prolonged period of time between sequential interventions (26.1%), omission of an indicated treatment (17.4%), deviation from recommended treatment guidelines (26.1%), and incorrect energy for defibrillation (10.1%). A pharmacist was present at 36.5% of documented arrests. Compliance with ACLS treatment guidelines was more likely during resuscitations in which a pharmacist was present (59.3% vs 31.9%; p = 0.03).

CONCLUSIONS: Noncompliance with resuscitation guidelines was common during in-hospital resuscitation. The presence of a pharmacist on the resuscitation team was associated with improved compliance with treatment guidelines. Despite institutional requirements for pharmacist participation during resuscitation efforts, participation rates remain low. Further evaluation of the role of the pharmacist on the resuscitation team and the impact of the pharmacist on resuscitation practices should be considered.

Key Words: advanced cardiac life support guidelines, pharmacist intervention

Published Online, March 18, 2008. www.theannals.com, DOI 10.1345/aph.1K475